The Effects of Neuromonitoring and Cerebrolysin Administration on Outcomes in Patients with Traumatic Brain Injury-An Interventional Pilot Study

INTRODUCTION

Traumatic brain injury (TBI) is one of the most common causes of death and an important burden to the worldwide healthcare system and society. There is a lack of guidelines for types of monitoring or neuroprotective therapy. The aim of this pilot study was to assess its feasibility and, furthermore, to evaluate the impact of Cerebrolysin on the following clinical outcomes: length of stay, Glasgow Outcome Scale (GOS) and mortality.

METHODS

A cohort of 56 patients was included in this non-randomised, real-time, pre-post-interventional study. The patients were assessed with the Glasgow Coma Scale (GCS) and divided into two groups: severe (GCS < 8) and non-severe (GCS > 8). After the radiological examination (CT scan), the patients were qualified for an immediate neurosurgical procedure if needed. The patients were admitted to the intensive care unit, where a standardised protocol for TBI treatment was implemented. Additional neuromonitoring was applied.

RESULTS

There were 56 patients (19 females; 33.9%), of which 41 were considered severe cases; the patients were allocated to the Cerebrolysin (n = 25) or control groups (n = 31). In a generalised linear model (GLM) approach, the use of Cerebrolysin was associated with a decrease in the probability of death in non-severe patients (by 0.333 (standard error (SE) = 0.157, p = 0.034)) but not in severe patients (estimate (Est.) = -0.115, SE = 0.127, p = 0.364). Patients who received Cerebrolysin and who were neuromonitored had favourable outcomes and better survival rates.

CONCLUSIONS

A multimodal treatment approach with monitoring and Cerebrolysin may have a beneficial effect on patients with less severe TBIs; however, the present study has multiple limitations, and further research is needed.

Increased distance or time from a major trauma centre in South Australia is not associated with worse outcomes after moderate to severe traumatic brain injury

OBJECTIVE

Considerations in traumatic brain injury (TBI) management include time to critical interventions and neurosurgical care, which can be influenced by the geographical location of injury. In Australia, these distances can be vast with varying degrees of first-responder experience. The present study aimed to evaluate the association that distance and/or time to a major trauma centre (MTC) had on patient outcomes with moderate to severe TBI.

METHODS

A retrospective cohort study was conducted using data from the Royal Adelaide Hospital's (RAH) Trauma Registry over a 3-year period (1 January 2018 to 31 December 2020). All patients with a moderate to severe TBI (Glasgow Coma Scale [GCS] ≤13 and abbreviated injury score head of ≥2) were included. The association of distance and time to the RAH and patient outcomes were compared by calculating the odds ratio utilising a logistic regression model.

RESULTS

A total of 378 patients were identified; of these, 226 met inclusion criteria and comprised our study cohort. Most patients were male (79%), injured in a major city (55%), with median age of 38 years old and median injury severity score (ISS) of 25. After controlling for age, ISS, ED GCS on arrival and pre-MTC intubation, increasing distance or time from injury site to the RAH was not shown to be associated with mortality or discharge destination in any of the models investigated.

CONCLUSION

Our analysis revealed that increasing distance or time from injury site to a MTC for patients with moderate to severe TBI was not significantly associated with adverse patient outcomes.

Outcome of early rehabilitation of patients with traumatic brain injury during COVID-19 pandemic in The Republic of Srpska, Bosnia and Herzegovina

Introduction

The COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period.

Materials and methods

A retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student t-test and Pearson correlation coefficient were used in statistical analysis. The value (p < 0.05) was used for statistical significance.

Results

A total of 174 patients with TBI were included in this study. Most of the patients (n = 94) were older than 60, male (n = 125) and the most frequent cause of TBI was falling over (n = 88). About a half (n = 92) had a mild TBI, almost one third of the sample had moderate (n = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), (p < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients.

Conclusion

The COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.

Decompressive Craniectomy and Shunt-Amenable Post-Traumatic Hydrocephalus: A Single-Center Experience

Background

Prior studies have shown that decompressive craniectomy may be an independent risk factor for the development of post-traumatic hydrocephalus (PTH). It is upon this background that we chose to conduct our single-center retrospective study to establish the possibility of an association between decompressive craniectomy and PTH.

Methods

A retrospective review involving a database of all patients with traumatic brain injury was undertaken. All referrals and admissions with traumatic brain injury, as defined by the Mayo Classification, from January 2012 to May 2022, were included in the subsequent analysis. Statistical analysis was carried out using IBM SPSS version 28.0.1.

Results

The mean age of the cohort was 44.91 ± 19.16 with more males (82.3%) than females (17.7%). Vehicle incident/collision was the most common cause of traumatic brain injury. 84% of the cohort was alive at 30 days, 4% were noted to have an intracranial infection, and 3% underwent shunt insertion procedures, while 14% received decompressive craniotomies as part of their clinical management. There was a statistically significant association between undergoing decompressive craniectomy, and the development of PTH (odds ratio, 4.759 [95% confidence interval, 1.290-17.559]; P = 0.019). The presence of intracranial infection and insertion of an external ventricular drain insertion were also independent predictors of developing PTH.

Conclusions

This study adds to the growing body of work regarding the immediate and long-term effects of the procedure. Although life-saving, PTH, needing shunt insertion, is one of the possible complications that surgeons and patients should be aware of.

Effect of Race and Nativity on Functional Outcomes Following Traumatic Brain Injury Among Asian, Hispanic, and Non-Hispanic White Survivors in the United States: A NIDILRR TBI Model Systems Study

OBJECTIVE

To compare the racial/ethnic differences in traumatic brain injury (TBI) recovery among Asians, Hispanics, and Whites, and explore the effect of nativity in the recovery process.

SETTING

Six Traumatic Brain Injury Model Systems (TBIMS) centers.

PARTICIPANTS

In total, 7953 patients who had at least 1 severe TBI between 2000 and 2016 were admitted to one of the TBIMS centers.

DESIGN

Secondary data analysis.

MAIN MEASURES

Functional Independent Measure (FIM instrument) ratings.

RESULTS

Asians had the lowest injury severity at admission, but they failed to make the improvements made by the Hispanics and the Whites between the rehabilitation discharge and the 1-year follow-up. The magnitude of improvement made by the foreign-born Asians was less than that made by their native-born counterparts. Both Asian and the Hispanic groups had lower functional outcomes at the 1-year follow-up, and the differences in functional outcomes between the Asian and Hispanic groups were not statistically significant. The above racial/ethnic disparities in functional outcomes were not fully explained by differences in sociodemographic status, injury characteristics, and immigration-related factors. The effect of nativity was mediated by covariates.

CONCLUSIONS

This study reveals racial/ethnic disparities post-TBI functional recovery. Despite lower injury severity and apparent financial resource advantages, Asians did not experience better functional outcomes. Although the effect of nativity was not established in this study, contextual factors related to ethnicity and immigration experiences should be further investigated.